Emergency Contraception – “Morning After Pill”

Emergency contraception provides an important safety net when you have sexual intercourse and no contraception is used or the contraception used is compromised (missed birth control pills, missed Depo injection, condom slips/breaks, etc.).

Emergency contraception pills are hormone-containing pills taken to give you a burst of hormonal contraception, which will likely prevent ovulation, fertilization, and/or implantation. Emergency contraception will not harm an already existing pregnancy.

You should take the emergency contraception pill as soon as possible; up to 120 hours (5 days) after unprotected sex.

Emergency contraception pills are free to all Yale students and Yale Health members when acquired at the Yale Health Center.

Emergency Contraception Pills

• My Way (Plan B – levonorgestrel) is available over-the-counter, without a prescription.
• Ella (ulipristal) is available by prescription from a provider in Student Health, OB/GYN or Acute Care.

(See Emergency Contraception Comparison Chart and/or contact the Yale Health Ob/Gyn Department if you’re not sure which option is best for you.)

Where to Get Emergency Contraception at the Yale Health Center

(free for all Yale students, and all Yale Health members)

• Yale Health Pharmacy (either going to the Pharmacy directly, or after consulting with a provider in one of our clinical departments)
• Acute Care

Other Locations (purchase price varies)

• Commercial pharmacies, like CVS, Walgreens, etc.

Effectiveness

Emergency contraception pills reduce the risk of pregnancy by approximately 75%. In other words, out of 100 women who have unprotected intercourse mid-cycle, approximately 8 would become pregnant. With use of emergency contraception pills, only 2 of the 100 would become pregnant. 

• My Way becomes less effective if used 3-5 days after unprotected sex, while Ella’s effectiveness stays the same for the full 5 days.
• Both medications are less effective for obese women. My Way retains its effectiveness up to a BMI of 30. Ella is effective up to a BMI of 35.
• My Way is less effective when unprotected sex occurs closer to the time of ovulation. Ella is more effective than My Way closer to ovulation.

Side Effects of Emergency Contraception Pills

The most common side effect is nausea, with or without vomiting. There are ways to decrease this if you become nauseous easily. Take the pill with food. You may elect to take prescription or over-the-counter anti-nausea medications about 30 minutes prior to the first dose of an emergency contraception pill. 

Safety

In 1997, the Food and Drug Administration reviewed the evidence and concluded that emergency contraception pills are safe and effective. In 2006, the FDA approved the sale of Plan B/My Way over the counter (OTC).

If you happen to already be pregnant and take emergency contraception, the hormones in emergency contraception pills have been shown not to affect the baby.

Important Note: Emergency contraception should not be used as your primary method of birth control. It is much less effective than methods designed for continuous protection from pregnancy. If you pick up 4 or more emergency contraception pill doses in a year, the Yale Health Pharmacy will notify the Ob/Gyn Department, so they can reach out to discuss better options for preventing pregnancy.

Taking the Medication

A Yale Health nurse or pharmacist will give you a dose of My Way, or you may have a provider prescribe Ella for you.

The treatment consists of one pill. If your provider recommends an antinausea medication, take it first. Wait 30 minutes to one hour and then take the emergency contraception pill. It is helpful to take the pill with food, and not on an empty stomach.

Your period may start a few days earlier or a few days later than expected. If it does not start within a week of when expected, you should come in for a pregnancy test and/or evaluation.

If you have not started your period within 3 weeks from the date of using emergency contraception, you should come in for a pregnancy test and/or evaluation. If you feel pregnant sooner, you should do a pregnancy test at that time.

Reasons Not to Take Emergency Contraception

Emergency contraception pills might not be a good option for you if you have a history of allergy to the medication, if you are significantly overweight, or if the unprotected sex occurred more than 120 hours earlier. There are no known medical conditions for which emergency contraception is unsafe.

Remember, even if it’s been more than 120 hours, and the episode occurred at mid-cycle, the chances of becoming pregnant are still low (less than 10%).

Additional Option

The Paragard copper-containing IUD, if inserted within 5 days (120 hours), provides over 99% effective emergency contraception, plus ongoing effective contraception for up to 10-12 years. It is inserted with a minor office procedure in the Ob/Gyn Department. You can make an appointment via MyChart or by calling 203-432-0222.

Additional Concerns

If barrier contraception (condom) wasn’t used, or if it failed, you should consider the chance that you’ve been exposed to a sexually-transmitted infection (STI). You should discuss this further with a nurse or provider.

If the sex was unprotected because it was nonconsensual (for example, sexual assault or date rape), please talk to one of our caregivers to learn about the resources available to you at Yale, including The Share Center.

Plan B FAQs | Plan B One-Step®

We made it easy and put them all in one place.

• Plan B One‑Step sometimes referred to as the “morning after pill,” is emergency contraception pill that helps prevent pregnancy before it starts when taken within 72 hours after unprotected sex.

  Plan B is a backup method of preventing pregnancy and should not be used as regular birth control. Use as directed.

• Plan B can significantly decrease the chance that you get pregnant. When used as directed, about 7 out of every 8 women who could have gotten pregnant did not become pregnant after taking Plan B.

• Birth control (or contraception) is any method, medicine, or device used to prevent a pregnancy before it starts. There are many different types of birth control. Some work better than others at preventing pregnancy and no method is 100% effective. But your chances of getting pregnant are lower if you use a more effective method.

  Primary methods of birth control are meant to be used before sex to prevent a pregnancy. These methods can range from things like condoms (which can be found right at the store without a prescription) to birth control pills or IUDs (which need to be prescribed by your doctor).

  Emergency contraception (like Plan B) is a form of birth control that is meant to be used if your primary method failed (like a condom broke or you missed pills) or you forgot to use primary birth control. Plan B is used to help prevent pregnancy after sex and must be taken within 72-hours after unprotected sex or if your primary birth control failed. The sooner you take it, the better it will work. It is not meant to be used as a regular form of birth control because it is not as effective.

  If you find that you are using Plan B frequently, talk to your doctor about finding a primary birth control method (a “plan A” method) that is right for you.

• org/Question”>

  We continue to hold the same belief as the U.S. Food and Drug Administration (FDA), which states that there are no safety concerns that preclude the use of levonorgestrel emergency contraceptives in women generally, and continue to believe that all women, regardless of how much they weigh, can use Plan B to prevent unintended pregnancy following unprotected sex or contraceptive failure. The most important factor affecting how well Plan B works is how quickly it is taken. When Plan B emergency contraception is taken as directed, within 72 hours after unprotected sex or birth control failure, it can significantly decrease the chance that a woman will get pregnant. In fact, the earlier the product is taken after unprotected intercourse, the better it works.

  Emergency contraception is not meant to be used as a regular form of birth control because it is not as effective. If you find that you are using Plan B frequently, talk to your doctor about finding a primary birth control method that is right for you.

• Plan B helps prevent pregnancy by temporarily delaying ovulation. That is, it works by stopping the release of an egg from the ovary, so there’s no egg to meet the sperm. No egg, no fertilization, no pregnancy.

• Plan B will not impact your ability to get pregnant in the future.

• Plan B is not an abortion pill and it will not be effective if a woman is already pregnant. Plan B will not harm an existing pregnancy.

• Yes! Plan B does not impact the effectiveness of any regular birth control methods, so you can continue your regular birth control right away—or start one, if you don’t have a regular method.

• Plan B, sometimes referred to as the “morning after pill,” is emergency contraception you can take after:

  • You didn’t use any form of birth control or had unprotected sex
  • There was an issue with your regular birth control method (eg, the condom broke or slipped)
  • You missed a dose (or more) of your regular birth control pill

  Use the countdown calculator

• You should take Plan B up to 72 hours (3 days) after unprotected sex. The sooner it’s taken after unprotected sex, the better it works.

• Plan B One‑Step is one pill that you place in your mouth and swallow, preferably with water. You can take Plan B with or without food. The most important thing to know about taking Plan B is that it must be taken within 72 hours (3 days) after unprotected sex to help prevent pregnancy before it starts. The sooner you take it, the better it works.

• Yes, you can use Plan B when you are breastfeeding. In general, no harmful effects of progestin-only pills, like Plan B, have been found on breastfeeding performance or on the health, growth, or development of the infant. However, random cases of decreased (less) milk production in mothers have been reported.

• Plan B emergency contraception should not be used as a regular method of birth control. However, if you have already used Plan B, it can be safely used again after another instance of unprotected sex or birth control failure. It will not affect a woman’s future fertility.

  Plan B doesn’t provide long-term protection against future pregnancy—it works to help prevent pregnancy after only one act of unprotected sex or birth control failure.

• Plan B only stays in your body for a short amount of time. It doesn᾿t provide long-term protection against future pregnancy; when taken as directed it works to help prevent pregnancy after only one incident of unprotected sex. If you are sexually active, even occasionally, see your healthcare professional or visit a family planning center/clinic to find a regular method of birth control that suits you.

  Find a Family Planning Clinic

• Do not take Plan B:

  • If you’re already pregnant, because it won’t work
  • If you’re allergic to levonorgestrel or any of the ingredients in Plan B
  • In place of regular birth control
  • If you’re male

  This product is not intended for use in postmenopausal women.

  Use before the first menstrual period is not appropriate.

• When used as directed, Plan B is safe and effective.

  Some women may experience side effects, including:

  • a period that’s lighter, heavier, early, or late
  • nausea
  • lower abdominal cramps
  • tiredness
  • headache
  • dizziness
  • breast tenderness
  • vomiting

  Some women taking Plan B may have changes in their period, such as spotting or bleeding before their next period. If your period is more than a week late, it’s possible you might be pregnant. Get a pregnancy test and follow up with your healthcare professional.

  If you vomit within 2 hours of taking Plan B, talk to your healthcare professional to find out if you should repeat the dose.

• org/Question”>

  Examples of drugs or herbal products that could decrease the effectiveness of Plan B include barbiturates, bosentan, carbamazepine, felbamate, griseofulvin, oxcarbazepine, phenytoin, rifampin, St. John᾿s wort, topiramate, and certain HIV/AIDS medications.

  Contact your healthcare professional before taking Plan B if you have any concerns or are taking any of these medications.

• No. You can find Plan B yourself in the family planning aisle—no prescription or ID needed. There’s also no age requirement—anyone can buy it.

• No. Plan B is available for purchase in every state—no prescription or ID needed. There’s also no age requirement. Anyone can buy it.

• org/Question”>

  First and foremost, Plan B is an emergency contraceptive—it is not an abortion pill, and it does not hurt existing pregnancies. Plan B and other emergency contraception brands have been approved since 2013 for purchase without a prescription, ID or age restriction. Plan B can be found at all major retailers across the country, in every US state, in the family planning aisle.

  The availability and access of Plan B is governed nationally by the U.S. Food and Drug Administration (FDA). Plan B is not in any way connected to Roe v Wade. Plan B will continue to be made available at all major retailers without a prescription, ID or age restriction regardless of any rulings on abortion restrictions.

  Foundation Consumer Healthcare will continue to advocate that no legal barriers should limit a woman’s access to Plan B emergency contraception.

• Plan B has a shelf life of four years. For the exact month and year that the Plan B is set to expire, you can refer to the information printed on the side of the box. Store the product at room temperature between 68‑ and 77‑degrees Fahrenheit.

• You can find Plan B yourself in the family planning aisle of all major retailers, including CVS, Walgreens, Rite Aid, Target, and Walmart. It’s also available at smaller pharmacies and some food stores around the country.

  Find a store

  Prefer to order Plan B online? You can buy it directly from our site.

  Remember, Plan B must be taken within 72 hours (3 days) after unprotected sex. If you need it right away, you can get it right off the shelf at the stores above.

• Yes. Plan B is available online here.

  Remember, Plan B must be taken within 72 hours (3 days) after unprotected sex. If you need it right away, you can get it right off the shelf at local retailers. Wondering where Plan B is stocked in your area? Find a store near you.

• There are two ways to save on Plan B: a coupon or a rebate.

  How to save

  Offers cannot be combined.

• Not sure how to bring up the topic of taking Plan B? Try the tips below.

  • Start with the facts. This site is full of information to help you have a conversation about Plan B—whether it’s with a friend, family member, or partner.
  • Plan ahead. Consider making a list of what you want to discuss and try practicing the conversation out loud. Think about potential responses to any concerns your friend/family member/partner might have.
  • Find the right time and place. Make sure you have a private place to discuss Plan B—a place where you won’t get interrupted or feel rushed.
  • Be respectful. Respect what the other person is thinking and feeling. Be open to other opinions, but remember: it’s your body and your choice.
  • Practice safe sex. Discuss future contraception. Safe sex is important, even if you’re in a monogamous relationship (remember: neither birth control pills nor emergency contraception like Plan B protect against STDs or HIV/AIDS).

• You can find downloadable PDFs, fact sheets, and more from Plan B on our resources page.

  Check out the websites below to stay informed on what’s happening in women’s healthcare, and to learn more about birth control options and emergency contraception.

  Planned Parenthood

  FDA

  American Society for Emergency Contraception

  Mayo Clinic

  Henry J. Kaiser Family Foundation

  National Family Planning & Reproductive Health Association

  Find a Family Planning Clinic

  Foundation Consumer Healthcare is not responsible for the content on the websites listed above and disclaims any liability for the content of any page or site listed above.
  Although the information above may be useful, it shouldn’t replace the advice of your healthcare professional. For questions about birth control and other women’s health issues, please talk to your healthcare professional.

Use of emergency contraceptives, effectiveness, side effects, long-term use

How do contraceptives work in case something goes wrong? How effective are they? What side effects can occur? Can I use “Plan B” as the main method of contraception?

Emergency contraceptives have been developed to help women avoid abortion after unprotected intercourse, when there is doubt about the effectiveness and correct use of other protection methods, or after sexual assault.

Emergency contraceptive methods

Hormonal preparations

• 1 Tablets containing levonorgestrel
• 2. Tablets containing ulipristal acetate
• 3. Combined oral contraceptives containing ethinyl estradiol and levonorgestrel

The method is effective in 95% of cases. The principle of action of all these funds is to suppress or delay ovulation. The pill is recommended to be taken as soon as possible. Levonorgestrel is effective within 72 hours, other groups of drugs – within 120 hours after sexual intercourse.

If vomiting occurs within 2-3 hours after the tablet, the drug should be repeated. The first two groups of tablets are preferable, as they cause fewer side effects.

The effectiveness of drugs may be reduced by interaction with a number of other drugs.

Copper IUD

The IUD is a small T-shaped device made of plastic and copper. The spiral changes the chemical composition of the mucus in the cervix, preventing the fertilization of the egg.

The coil must be inserted within 5 days after intercourse. This method is considered the most effective among all means of emergency contraception: pregnancy occurs in only 1% of cases.

The coil can be left as the main method of contraception, but in this case, you should expect more prolonged and heavy menstrual bleeding.

Side effects of emergency contraceptive drugs

In general, drugs do not cause any serious side effects.

In some cases, there may be:

• – Failure of the menstrual cycle (earlier or later than usual)
• – Spotting
• – Nausea and vomiting
• – Fatigue
• – Headache and dizziness
• – Breast sensitivity
• – Abdominal pain

For more severe reactions, it is recommended to make an appointment with a doctor. Sharp pain in the lower abdomen may indicate an ectopic pregnancy.

Side effects of emergency IUD insertion

Usually IUD insertion does not cause adverse reactions. The method is not recommended for use after sexual abuse due to the high risk of developing genital infections.

Emergency contraception as a last resort

Emergency contraception does not interfere with reproductive function and has no long-term health effects. However, for the main method of protection against unwanted pregnancy, other means should be chosen.

These products were developed as a last resort only and have not been tested for efficacy and safety in regular long-term use.

The material was prepared jointly with the head of the Lahta Woman gynecological service, obstetrician-gynecologist Ekaterina Khivrich

Emergency contraception: “I got pregnant despite the pill”

9011 7 Natasha Presky
• BBC Three

10 November 2019

Photo credit: BBC THREE/ISTOCK

Warning: This article contains references to sexual assault that may be distressing.

“It never occurred to me that the emergency contraceptive pill would be ineffective.”

Rachel (not her real name) became pregnant after being raped in Canada, where she went after graduation. She was given an emergency contraceptive pill that evening, as part of the medical care she received after the attack.

“When I found out two months later that I was pregnant, it was a complete shock for me,” she recalls. “It never even crossed my mind that this could even happen.”

Rachel, now 34, says she wasn’t told she could still get pregnant after taking emergency contraception: “I don’t remember it being mentioned at the time (the pill. – Rev. .) may not work.”

• What is the most effective method of contraception?
• Women refuse birth control pills. What do they choose instead?
• “Contraceptive pills have made my life a nightmare”

It is estimated that 0. 6-2.6% of women who take emergency contraceptive pills after unprotected sex still get pregnant.

What people know – and what they don’t know – about emergency contraception began to be discussed after the author of the site Refinery29 told how she got pregnant despite taking the pill.

The article went viral and there were calls for greater awareness that emergency contraceptive pills do not protect against unwanted pregnancies.

How do emergency contraceptive pills work?

• Synthetic hormones prevent or delay ovulation (the release of an egg from the ovary)
• If you ovulated before you took the pill and you were fertile during unprotected sex, it will not protect against pregnancy
• This means that the pill emergency contraception may not be effective even if you take them correctly – it all depends on the menstrual cycle
• Ovulation usually occurs in the middle of the cycle (about two weeks before menstruation)
• There are two types of emergency contraceptive pills: levonorgestrel and ulipristal acetate
• Levonorgestrel should be taken within 72 hours (three days) after unprotected sex
• Ulipristala acetate needed take within 120 hours (five days)

Photo credit, BBC THREE/ISTOCK

Some medications can also interfere with the effectiveness of pills, says Dr. Caroline Cooper, reproductive and sexual health specialist.

“These are the drugs that can affect how your liver processes drugs,” she explains. Among them are some medicines for HIV, epilepsy, and the over-the-counter herbal remedy St. John’s wort, which is sometimes taken to treat mild mood disorders.

Another reason why emergency contraceptive pills may not work is a woman’s weight, explains Dr. Cooper. Women who are overweight have a higher risk of getting pregnant after taking them, she says. “And it’s not even about being overweight,” adds Dr. Cooper.

She says the risk of levonorgestrel failure is much greater if a woman weighs over 70 kg or has a body mass index over 26 (according to the British Health Service, the ideal BMI for most adults is between 18.5 and 24.9).

“Complete surprise”

But how many women know about all this? Although the instructions for emergency contraceptive pills contain information that the drug’s effect is based on delayed ovulation, it, like everything written in fine print, is easy to ignore. The instruction also does not directly say that the effectiveness of the tablets depends on that day of the menstrual cycle. So why, along with emergency contraceptive pills, are women not given all the information they need?

“I didn’t expect it to not work,” Harriet, 26, told me. During sex, the condom broke, and she resorted to emergency contraception – but she got pregnant anyway, although she took the pill right away and did everything according to the instructions.

Harriet adds that she was told that pills sometimes don’t work, but the only risk factor mentioned was taking the pill too late. Since she did it within 24 hours, she wasn’t worried. About a week later, she found out she was pregnant.

• Have we fallen out of love with safe sex?
• Scientists create new self-lubricating condoms

For Rachel, not knowing that the pill might not work made her situation even more difficult. “I wouldn’t change anything – my son is 15, it can be very difficult with him, but I wouldn’t want his mother,” she tells me. “But then … I think that such an unexpected pregnancy was very traumatic for me.”

I ask Dr. Cooper if women are always told in a pharmacy or sexual health clinic that their menstrual cycle affects the effectiveness of emergency contraceptive pills.

“I think they should do this,” she says, adding that while pharmacists usually know how emergency contraception works, “if they’re busy, they might not go into all the details.” BBC THREE

Gold Standard

Another available method of emergency contraception is the copper IUD (intrauterine device) inserted within the first five days after unprotected sex.While the pill delays ovulation, the IUD prevents implantation of the fertilized eggs on the uterine mucosa and has an efficiency of 99%.

It is estimated that two out of every 100 women who use ulipristal acetate become pregnant and 0. 6-2.6% of women who use levonorgestrel.

Neither Harriet nor Rachel suggested IUDs as an alternative to pills.

Rebecca Pickerill, a sexual health nurse at Brook’s youth sexual health charity, says their workers always offer IUDs as the “gold standard.”

“We find out when they last had unprotected sex, when they had their last period, cycle length, estimated date of ovulation, which of course is only an approximation – usually ovulation occurs in the middle of the cycle, but obviously not everyone,” she says.

“Then we discuss with them which of the two types of oral contraceptives is best for them … but always emphasize that the IUD is the most effective.”

Dr. Cooper says she has never seen an IUD fail as an emergency contraceptive. “But I have certainly seen women who take emergency contraceptive pills, get pregnant, have an abortion, and then come to me to have a coil inserted, and were furious that no one offered them this option right away,” she adds.

“Men should know it too”

Sexual and reproductive health specialist Dr. Jane Kavanagh thinks emergency contraception should be taught in schools.

• New male contraceptive tested on monkeys

“It is outrageous that every child is not taught about contraception and what to do if they have had sex and there is a risk of pregnancy,” she says. school.”

“I did a small focus group with my teenage daughter’s friends a few years ago, aged 14-15,” she continues. “There were about six girls in the room, and I just asked them, ‘Who knows that an IUD can be used for emergency contraception?” and she was the only one who knew that.”

Harriet adds that it’s not just women who need to be told more about emergency contraception. “I think men should also know more about it,” she says. She says that there were some among her partners who told her that in the morning she could just go to the doctor for pills.